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– occurs in 3-5% of all pregnancies, most common malpresentation, sometimes can get baby to turn; incidence is related to gestational age (more common in preterm baby); more risk of breech with multiples; more likely if hydramniosoTypes of BreechFrank– most common, legs up in front of faceFootling– foot is coming outComplete– baby is sitting Indian styleoBreech babies are more liked to have congenital anomaliesRisks: omom – more tearsoBaby – trauma to presenting partoProlapsed cord – greater risk if baby is breeched; put mom’s head of bed back so baby hopefully moves back C/SWhat to do for malpresentation?oMay try an external cephalic version (ECV) – goal is to prevent a C/SDeliberately altering fetal position; can be done externally or intrauterineRelax uterus & try to get baby to turn head downGive Mag Sulfate or TerabutlineExternally Done at 37 weeks’ gestation because may induce laborDO NOT want water to break so need intact membranes and normal amount of amniotic fluidReactive NST to make sure baby is okPresenting part not engagedMacrosomia baby: >8.5 pounds/ 4,000 gramsoMost common complication is shoulder dystocia43
oMcRobertsPosition– pull knees closer to chest; widens the angle of the pelvis for deliveryoRisks Complicated laborTrauma to mom – lacerationsTrauma to baby – Clavicle breaking Heals on its ownErb’s palsy- trauma to side of body that had to pulledUsually temporaryMay require physical therapyNon-reassuring fetal status/fetal distressoNotable clues: decreased FHR (fetal heart rate)meconium stained fluidWhat to do?oPlace mom on her side – preferably left sideoGive oxygen to momoIV fluids to momoMonitor babyoPrep for deliveryAssessment of fetal well-being/development/maturity in pregnancy (to include various procedures implemented)Assessment of fetal wellbeing:Indications for testingAge of Mom (younger or older)Maternal Conditions (HTN, DM)Rh Isoimmunization (sensitized to Rh factor, antibodies, baby is at risk for hemolytic disease of the newborn)Hx. of stillbirth (concerned, may need special testing)oIUGR (intrauterine growth restriction) (>42 weeks gest.)Amniotic Fluid Concerns (oligiohydramnios, polyhydramnios)Multiples (increases risk)Abnormal test results during pregnancy (red flags)Normal newborn assessment findings (to include V.S., Apgar, skin, physical characteristics, reflexes, stools, weight gain/loss, gestational age determination, etc. Review NB information from lab day)Apgar 1 and 5 minutes 0-3 severe distressNormal pulse:120-160 (low as 100 during sleep, high as 180 during crying)Respirations:30-60, brief periods of apneaTemperature97.5-99 (AxillaryB/P: 90-60/50-40 mm Hg at birthoMaintain clear airway, neutral thermal environmentWithin one hour of birth: single injection of vitamin K to the vastus lateralis muscleOphthalmic erythromycin ointment to preventeye infection from gonorrheaor Chlamydia, which can cause blindnessWithin one hour of birthSigns of neonatal distress:o